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  <h1 class="page-title">输入订单</h1>
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<div class="container-fluid">
  <div class="row-fluid">
  <p>&nbsp;</p>
<div class="well">
<form>
 &nbsp;<button class="btn"><i class="icon-trash"></i>&nbsp;清空</button>
 &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
  <button class="btn btn-primary"><i class="icon-save"></i>&nbsp;确认</button>

   <br>
   <p></p>
<label class="help-inline">订单ID</label>
<input type="text" class="input-small">
&nbsp;&nbsp;&nbsp;&nbsp;
<label class="help-inline">收寄地</label>
<select name="DropDownTimezone" id="DropDownTimezone" class="input-small">
          <option selected="selected" value="Please">请选择</option>
          <option value="Beijing">北京</option>
          <option value="Shanghai">上海</option>
          <option value="Tianjin">天津</option>
          <option value="Chongqing">重庆</option>
          <option  value="Harbin">哈尔滨</option>
          <option value="Changchun">长春</option>
          <option value="Shenyang">沈阳</option>
          <option value="Shijiazhuang">石家庄</option>
          <option value="Taiyuan">太原</option>
          <option value="Nanjing">南京</option>
          <option value="Hangzhou">杭州</option>
          <option value="Hefei">合肥</option>
          <option value="Fuzhou">福州</option>
          <option value="Nanchang">南昌</option>
          <option value="Jinan">济南</option>
          <option value="Zhengzhou">郑州</option>
          <option value="Wuhan">武汉</option>
          <option value="Changsha">长沙</option>
          <option value="Guangzhou">广州</option>
          <option value="Haikou">海口</option>
          <option value="Chengdu">成都</option>
          <option value="Guiyang">贵阳</option>
          <option value="Kunming">昆明</option>
          <option value="Xi'an">西安</option>
          <option value="Lanzhou">兰州</option>
          <option value="Xining">西宁</option>
          <option value="Taipei">台北</option>
          <option value="Huhehot">呼和浩特</option>
          <option value="Lhasa">拉萨</option>
          <option value="Nanning">南宁</option>
          <option value="Yinchuan">银川</option>
          <option value="Urumqi">乌鲁木齐</option>
          <option value="HongKong">香港</option>
          <option value="Macao">澳门</option>
        </select>
        &nbsp;&nbsp;&nbsp;&nbsp;
        <label class="help-inline">收寄日期</label>
        <input type="date" class="input-medium">
        &nbsp;&nbsp;&nbsp;&nbsp;
        <label class="help-inline">配送地</label>
        <select name="DropDownTimezone" id="DropDownTimezone" class="input-small">
          <option selected="selected" value="Please">请选择</option>
          <option value="Beijing">北京</option>
          <option value="Shanghai">上海</option>
          <option value="Tianjin">天津</option>
          <option value="Chongqing">重庆</option>
          <option  value="Harbin">哈尔滨</option>
          <option value="Changchun">长春</option>
          <option value="Shenyang">沈阳</option>
          <option value="Shijiazhuang">石家庄</option>
          <option value="Taiyuan">太原</option>
          <option value="Nanjing">南京</option>
          <option value="Hangzhou">杭州</option>
          <option value="Hefei">合肥</option>
          <option value="Fuzhou">福州</option>
          <option value="Nanchang">南昌</option>
          <option value="Jinan">济南</option>
          <option value="Zhengzhou">郑州</option>
          <option value="Wuhan">武汉</option>
          <option value="Changsha">长沙</option>
          <option value="Guangzhou">广州</option>
          <option value="Haikou">海口</option>
          <option value="Chengdu">成都</option>
          <option value="Guiyang">贵阳</option>
          <option value="Kunming">昆明</option>
          <option value="Xi'an">西安</option>
          <option value="Lanzhou">兰州</option>
          <option value="Xining">西宁</option>
          <option value="Taipei">台北</option>
          <option value="Huhehot">呼和浩特</option>
          <option value="Lhasa">拉萨</option>
          <option value="Nanning">南宁</option>
          <option value="Yinchuan">银川</option>
          <option value="Urumqi">乌鲁木齐</option>
          <option value="HongKong">香港</option>
          <option value="Macao">澳门</option>
        </select>
        &nbsp;&nbsp;&nbsp;&nbsp;
        <label class="help-inline">订单状态</label>
        <select name="DropDownTimezone" id="DropDownTimezone" class="input-small">
          <option value="accepted">已接受</option>
          <option value="onTheWay">未送达</option>
          <option value="nonDeilvery">未发货</option>
        </select>
        &nbsp;&nbsp;&nbsp;&nbsp;
        <label class="help-inline">备注</label>
        <input type="text" class="input-medium">
        <br>
        <p></p>
        <h5>&nbsp;寄件人资料</h5>
        <label class="help-inline">姓名</label>
        <input type="text" class="input-small">
        &nbsp;&nbsp;&nbsp;&nbsp;
        <label class="help-inline">电话</label>
        <input type="tel" class="input-medium">
        &nbsp;&nbsp;&nbsp;&nbsp;
        <label class="help-inline">单位电话</label>
        <input type="tel" class="input-medium">
        &nbsp;&nbsp;&nbsp;&nbsp;
        <label class="help-inline">地址</label>
        <input type="text" class="input-large">
        <br>
        <p></p>
        <h5>&nbsp;收件人资料</h5>
        <label class="help-inline">姓名</label>
        <input type="text" class="input-small">
        &nbsp;&nbsp;&nbsp;&nbsp;
        <label class="help-inline">电话</label>
        <input type="tel" class="input-medium">
        &nbsp;&nbsp;&nbsp;&nbsp;
        <label class="help-inline">单位电话</label>
        <input type="tel" class="input-medium">
        &nbsp;&nbsp;&nbsp;&nbsp;
        <label class="help-inline">地址</label>
        <input type="text" class="input-large">
        <br>
        <p></p>
        <h5>&nbsp;货物资料</h5>
        <label class="help-inline">重量(kg)</label>
        <input type="text" class="input-mini">
        &nbsp;&nbsp;&nbsp;&nbsp;
        <label class="help-inline">体积(m3)</label>
        <input type="tel" class="input-mini">
        &nbsp;&nbsp;&nbsp;&nbsp;
        <label class="help-inline">物品名称</label>
        <input type="tel" class="input-medium">
        &nbsp;&nbsp;&nbsp;&nbsp;
        <label class="help-inline">数量</label>
        <input type="text" class="input-mini">
        &nbsp;&nbsp;&nbsp;&nbsp;
        <label class="help-inline">货物类别</label>
         <select name="DropDownTimezone" id="DropDownTimezone" class="input-medium">
          <option value="normalGoods">普通商品</option>
          <option value="fragileGoods">易碎商品</option>
          <option value="valuables">贵重物品</option>
        </select>
        <br>
        <p></p>
        <h5>&nbsp;资费情况</h5>
        <label class="help-inline">保价金额(￥元)</label>
        <input type="text" class="input-mini">
        &nbsp;&nbsp;&nbsp;&nbsp;
        <label class="help-inline">资费(￥元)</label>
        <input type="tel" class="input-mini">
        &nbsp;&nbsp;&nbsp;&nbsp;
        <label class="help-inline">总计费用(￥元)</label>
        <input type="tel" class="input-mini">
        &nbsp;&nbsp;&nbsp;&nbsp;
        <label class="help-inline">支付</label>
          &nbsp;&nbsp;&nbsp;
          <label class="radio help-inline">
            <input type="radio" name="gender" value="male">
            寄件人</label>
          &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
          <label class="radio help-inline">
            <input type="radio" name="gender" value="female">
            收件人</label>
          &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
          <label class="radio help-inline">
            <input type="radio" name="gender" value="other">
            第三方支付</label>
            <br>
            <p></p>
            <label class="help-inline"><h5>发货日期</h5></label>
            <input type="date" class="input-medium">
</form>


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